Acute ligament injury of the ankle
Introduction
Brief introduction of acute ligament injury of the ankle Joint sprains are more common than joint dislocations, especially in the ankle joints. However, the general injury of the ankle ligament is often not taken seriously. The actual number of cases is several times that of the patients who come to see the doctor. The ligament injury is divided into two types: partial fracture and complete fracture. The former is called sprain or bruise of the ankle joint. The dislocation or subluxation of the ankle joint may occur. When the ligament of the triangle, the entire ligament of the lower jaw, or part of the interosseous membrane are simultaneously damaged, the sacral separation and the talar dislocation may occur, and the anterior iliac ligament injury of the external iliac crest may occur. The anterior tibiofibular ligament injury is more common, and the triangular ligament injury is often combined with ankle fracture and dislocation. basic knowledge The proportion of illness: 0.006% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
The cause of acute ligament injury in the ankle
(1) Causes of the disease
Direct violence, indirect violence and muscle strain can cause injury.
(two) pathogenesis
The violence that causes acute ligament injury of the ankle joint is roughly divided into three types: direct violence, indirect violence and muscle tension. Among them, indirect violence is mainly caused by inadvertently slamming on uneven roads or up and down stairs, and the ankle is extremely inverted. The flexion position causes the lateral collateral ligament to be excessively pulled to cause injury. The lighter part causes partial fracture of the infraorbital ligament. In severe cases, the ligament can be completely broken and the ankle joint is subluxated and dislocated, or because the distal end of the ankle is over-limit. Turning, external rotation directly causes damage to the medial malleolus and/or chin ligament. Most of these injuries coexist with internal hemorrhoids and/or lateral malleolus fractures.
Prevention
Prevention of acute ligament injury in the ankle
For a lighter ankle sprain, the next day, three times can be cured. For the heavier ankle sprain, it needs to be taken once a day. After three days, the swelling can be reduced once every other day, and it can be paralyzed for two weeks.
Complication
Complications of acute ligament injury of the ankle Complication
The medial aspect of the ankle has a tough medial ligament reinforced, the lateral anterior talofibular ligament, posterior tibiofibular ligament and the Achilles tendon ligament. These three ligaments originate in the lateral malleolus, the first two stop at the talus and the latter stop at the calcaneus. They are relatively independent and relatively weak. In sports, they often cause excessive varus due to violent force, which causes damage to the lateral ligament. In addition, when the ankle joint is flexed, the joint is loose, the stability is poor, and it is easy to sprain, especially the inversion sprain. Due to the special role of the joint in exercise, it is often difficult to heal. Therefore, we should pay more attention to protection and timely treatment. After the ankle sprain, the initial correct treatment is very important.
If the early treatment is improper, the ligament is excessively loose, which may cause the ankle joint to be unstable, which may cause repeated sprains, even joint cartilage damage, and traumatic arthritis, which seriously affects the walking function.
The sequelae caused by improper prevention and treatment of ankle sprains are as follows.
1. Insufficient muscle strength and decreased exercise capacity.
2. The active area of the ankle joint is lowered.
3, long-term pain and swelling of the foot and ankle.
4, the ankle joint is unstable, walking is not stable, prone to habitual ankle injury.
Symptom
Acute ligament injury symptoms of the ankle. Common symptoms. Anterior and inferior tibiofibular swelling and pain. Ankle pain, ankle swelling, infraorbital area, pain, swelling, ligament rupture, plaque, foot and ankle injury.
External malleolus ligament injury
The lateral malleolus ligament includes the anterior talofibular ligament, the iliac ligament and the posterior ligament.
As mentioned above, the external head of the humerus is about 1cm longer than the internal iliac crest. When the ankle is sprained, it is easy to cause varus injury, and the external ligament is relatively weak. Therefore, the lateral ligament injury is more common in the clinic. The flexion and extension position of the foot is different, and the involvement of the three groups of ligaments is also different. For example, the ligament injury is more than the anterior ligament in the plantar flexion, the ligament injury is the posterior ligament in the back extension, and the ligament injury is more in the middle position. see.
(1) anterior talofibular ligament: When the foot is under normal load, the anterior iliac ligament and the long axis of the talus travel in the same direction; when the plantar flexion, the direction of travel is consistent with the longitudinal axis of the tibia, and becomes tense. When subjected to varus stress, the anterior ligament of the iliac crest produces tear and complete rupture.
(2) sacral ligament: When the ankle joint is in a plantar flexion, if the varus stress is further increased, in addition to the anterior ligament injury, the iliac ligament may be damaged. If the ankle joint is in the neutral position, the ankle joint In the case of extreme varus, the iliac crest ligament is firstly damaged. The iliac crest ligament is the main structure in the lateral malleolar ligament. It is tough. When the ankle joint is functional, it acts to limit the inversion of the foot. The lateral space of the ankle joint is widened.
(3) posterior iliac ligament: the strongest bundle in the lateral malleolar ligament, mainly limiting the excessive extension of the ankle joint. The ligament injury after the sacral distance is mainly due to over-limit varus.
2. Inguinal ligament injury
The medial malleolar ligament, also known as the triangular ligament, is also divided into 3 bundles. The front is the anterior iliac ligament, the middle is the iliac ligament and the posterior iliac ligament. The ligament is divided into two layers, which are very tough and not easy to break. The main function is Restriction of ankle valgus and excessive external rotation. In most cases, the injury of the medial malleolar ligament is caused by valgus or external rotation. This external force usually causes a fracture of the medial malleolus and/or external malleolus, but if the violence is very sudden, Caused by triangular ligament rupture, in which simple ligament rupture is rare, more complicated with external malleolus fracture and / or lower ankle joint separation.
3. Lower ligament injury
The humerus of the lower jaw is located at the lower ankle joint. The ligament is divided into three parts: 1 anterior tibial ligament: from the humerus, obliquely outward and upward, in front of the humerus, 2 intercondylar ligament: from the lateral side of the lower end of the humerus to the tibia The medial side of the lower end is actually the continuation of the interosseous membrane. It is the strongest. The posterior tibiofibular ligament: from the posterolateral aspect of the lower end of the humerus to the medial aspect of the lower end of the humerus, the injury of the inferior tibiofibular ligament is mainly caused by valgus and external rotation. It is not clinically Rare, but easy to miss diagnosis; ligament ligament injury with or without collateral ligament fracture (with or without external malleolus fracture), usually the triangular ligament first fracture, so that the tensile stress of the lower ligament is suddenly increased, once it exceeds its maximum, then Cause breakage.
Symptoms
Most of the acute ligament injuries of the ankle joint have a clear history of trauma. Clinically, the patient can be found to have swelling and pain in the anterior and lateral blepharospasm, local tenderness, ecchymosis under the skin, limited joint activity and lameness, etc. When the pain is aggravated, the pain can be relieved when the extension and valgus are reversed. When the sacral joint is in the sacral position, the talus can be displaced forward. The ligament of the medial malleolus is damaged, swelling, and subcutaneous. In the case of bruising and bruising, the movement of the foot is limited. The fistula of the medial malleolus may have swelling and congestion. When the chin ligament is damaged, the symptoms are similar to the above, but the pain and swelling are in front of the ankle joint and not on the side.
5. Signs
When the external malleolar ligament is damaged, the local area has obvious tenderness. The ligament below the iliac crest is the most obvious, and it is more limited. It is easy to distinguish from the external iliac fracture. The ligament of the medial malleolus ligament is more than the attachment of the lower triangular ligament in the lower part of the iliac crest; In front of the ankle joint.
6. Special inspection
When the lateral malleolus ligament is damaged, the foot is passively inverted, the injured ligament is pulled and the pain is aggravated. If the forcible varus is affected, the sacral ligament fracture is enlarged. The medial malleolar ligament injury, forced valgus pain, and ligament may occur. The rupture at the fracture site, the fixation of the lower leg, the push of the heel before and after can increase the extent of the inner motion; when the chin ligament is damaged, holding the heel as the lateral or rotational movement of the talus, the range of talus activity can be found to increase.
Examine
Examination of acute ligament injury of the ankle
1. Imaging examination
When taking a positive lateral radiograph, the lower leg should be rotated 20° internally so that the transverse axis of the ankle is parallel to the X-ray cassette (Fig. 1), so that the entire joint gap is equal, and the subchondral bone of the tibia and talus is also Parallel (A), from the continuous line-up relationship between the subchondral bone plate at the lower end of the humerus and the subchondral line shadow of the lateral malleolus, a slight shortening of the humerus can be recognized, and the talus outward movement and the lateral gap widening can also be observed ( B), when the external ligament is damaged, only the local soft tissue swelling is seen on the conventional film. If the diagnosis is to be further clarified, the varus stress can be taken after the local anesthesia and compared with the healthy side. The normal valance angle is 5°~ 10° (the angle between the lower humerus articular surface and the talus articular surface for varus), such angle is 1 times larger than the healthy side, indicating anterior ligament rupture; more than 2 to 3 times, the anterior ligament and iliac crest With the ligament tear; more than 5 times, the external iliac ligament is completely broken, at this time, the distal radius fracture (C), the lateral position of the anterior and posterior talus without dislocation (D), when the anterior ligament injury, talus A forward semi-dislocation image (E) appears.
When the medial malleolar ligament is broken, the ankle valgus stress sheet can be taken under local anesthesia, and some of the infraorbital joints can be separated.
When the humeral ligament is damaged, the sacral contrast should be taken to observe the distance between the bilateral infraorbital joints; if necessary, the stress position after local anesthesia is taken, that is, the ankle joint is placed in the eversion, external rotation, inversion and normal A film, such as the separation of the humerus, regardless of the fracture of the humerus, indicates that the three ligaments are all broken, such as the lower end of the humerus is not abducted in the outreach position, only showing rotation, it indicates that the posterior iliac ligament is not broken, can also be single Ankle inversion film, if the tibia and fibula gap increased more than 3mm, it indicates that the inferior ligament ligament injury, showing the ankle subluxation.
2. Special inspection
Ankle joint angiography: The contrast agent can be found from the ankle joint into the fractured ligament injury. Magnetic resonance imaging (MRI) examination: MRI has good soft tissue resolution, can determine the extent of hematoma in the soft tissue of the ankle, and identify the tear of the ligament. Crack, fracture damage, etc.
Diagnosis
Diagnosis and diagnosis of acute ligament injury of the ankle
A clear history of trauma, when the external iliac ligament is damaged, the swelling of the anterior iliac crest, pain, local tenderness, subcutaneous ecchymosis, lameness, etc., when the medial malleolar ligament is injured, the inner and inferior region is painful, swollen, subcutaneous congestion, cyanosis, limited foot movement, lower When the patellar tendon is damaged, the symptoms are similar to the above, but the pain and swelling are in front of the ankle joint and not on the side.
X-ray examination and stress imaging can indirectly confirm the existence of ligament injury, and can also perform ankle angiography, or indirectly confirm the existence of injury, MRI can determine the extent of hematoma, identify the tear of ligament, the existence and extent of fracture damage .
